33-005 · EVIDENCE B · LOW-RISK READING
For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily
长期坐轮椅的，坐垫换成减压型，每天看一遍坐骨和尾骨
A pressure‑relieving cushion costs several hundred to over a thousand yuan. The daily check takes just one minute.
Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice.
B
Move “For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily” to Future Me's calendar
The excuse
The routine already works until the day the source says it may not.
What feels good now
Today I keep a little money, a few minutes, a bit of persistence and avoid interrupting my default routine.
What the source says
The source summarizes the return this way: “Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice.” Evidence grade B. The original states the population, caveats, and sources; this is not a personal forecast.
Open the original entry, check who the evidence applies to, then pick one small step that fits.
THE ENGLISH EDITION
Original recommendation and evidence
5. For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily
Cost: A pressure‑relieving cushion costs several hundred to over a thousand yuan. The daily check takes just one minute.
In plain terms: Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice.
Benefit: This randomized clinical trial took place in 12 nursing homes between 2004 and 2008, enrolling 232 residents aged 65 or older who used a wheelchair for at least 6 hours daily and had a Braden score ≤18. All participants received a properly fitted wheelchair and were then randomly assigned to two groups: one used skin‑protective cushions (air, viscoelastic fluid plus foam, or gel plus foam), while the other used segmented foam cushions 7.6 cm thick. Follow‑up lasted 6 months or until a pressure ulcer developed. For pressure ulcers at the ischial tuberosity, the segmented foam group had 8 cases (6.7%) versus 1 case (0.9%) in the skin‑protective group (P = 0.04). When both ischial and sacrococcygeal ulcers were counted, the segmented foam group had 21 cases (17.6%) and the skin‑protective group 12 cases (10.6%); this difference was not statistically significant (P = 0.14).
Evidence grade: B
Sources: Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. <https://doi.org/10.1111/j.1532-5415.2010.03168.x>
Notes: Two factors justify a B rating. First, the sample size was only 232 participants; the P‑value for the primary outcome (0.04) barely crossed the threshold, while secondary outcomes showed no difference. Second, the participants were elderly nursing‑home residents; results may not apply to younger wheelchair users. Since all subjects received a properly fitted wheelchair, both “proper fit” and “cushion type” contributed to outcomes; therefore, merely swapping the cushion is insufficient. For pressure‑ulcer prevention in bedridden individuals, air mattresses and regular repositioning are discussed in Section 17, Item 8 (Pressure ulcers). Information on applying for subsidies for basic assistive devices can be found in Section 7 of this chapter (contact the county disability‑services office).
Read the complete Chinese source and notes
5. 长期坐轮椅的，坐垫换成减压型，每天看一遍坐骨和尾骨
成本: 一个减压坐垫几百元到上千元。每天看一遍，一分钟。
说人话: 普通海绵坐垫压久了会把皮肤压破，破了愈合很慢，容易感染。养老院里用减压坐垫的老人，坐骨那里的压疮明显更少，但把尾骨一起算就没看出差别。轮椅本身也要按人的尺寸配，别买个通用款就算了。
收益: 这项随机临床试验在 12 家养老院做，2004 到 2008 年招募 232 名 65 岁以上、每天坐轮椅 6 小时以上、Braden 评分 18 分以下的住户。所有人先配了合身的轮椅，再随机分成两组。一组用皮肤保护型坐垫（空气、黏性流体加泡沫、或者凝胶加泡沫），一组用 7.6 厘米厚的分段式泡沫坐垫。随访 6 个月或者到发生压疮为止。坐骨结节部位的压疮，分段泡沫组 8 例（6.7%），皮肤保护型坐垫组 1 例（0.9%），P=0.04。把坐骨和骶尾部的压疮合起来算，分段泡沫组 21 例（17.6%），皮肤保护型坐垫组 12 例（10.6%），P=0.14，没有做出差别
证据等级: B
来源: Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. <https://doi.org/10.1111/j.1532-5415.2010.03168.x>
备注: 定 B 的原因有两条。一是样本只有 232 人，主要终点的 P 值 0.04 刚过线，次要终点没有做出差别。二是人群是养老院里的高龄住户，套到年轻的轮椅使用者身上属于往外推。试验里所有人都先配了合身的轮椅，所以「合身」和「坐垫」是一起起作用的，别只换坐垫。长期卧床的压疮防护，气垫床和定时翻身，见第 17 节第 8 条（压疮）。基本型辅助器具的配置补贴怎么申请，见本节第 7 条（去县级残联问全）。
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